Purpose of review: Necrotizing enterocolitis remains an enigmatic and potentially devastating condition with high morbidity and mortality. This review explores ways in which bacterial pathogens, together with gut microflora, influence the pathophysiology of necrotizing enterocolitis. Specifically, it examines the role of gut microbial colonization and its ‘normalization’ with probiotics vis a vis its contribution to intestinal bacterial invasion.
Recent findings: Recent studies have demonstrated that prophylactic administration of probiotics to preterm neonates decreases both the incidence and severity of subsequent necrotizing enterocolitis.
Summary: Probiotics represent a therapeutic effort to bolster natural host defenses via the ‘normalization’ of abnormal gut microflora of the premature infant at risk, thereby reducing the subsequent threat of necrotizing enterocolitis. The appeal of probiotics in neonatology is threefold. First, their safety record renders them an attractive alternative to many of the more aggressive therapeutic options; second, they represent a simple, noninvasive attempt to recreate a natural or normal flora rather than a disruption of nature. Third, probiotics are used mainly for disease prevention and are naturally occurring. As such, they are not considered to be drugs, but rather food supplements. To date, very few other strategies have been proven definitively to be efficacious in decreasing the incidence of necrotizing enterocolitis.